康柏西普联合玻璃体切割术治疗脉络膜脱离后增生性玻璃体视网膜病变

Clinical efficacy of Conbercept combined with vitrectomy for proliferative vitreoretinopathy after choroidal detachment

摘要:

目的：探讨康柏西普联合玻璃体切割术治疗脉络膜脱离后增生性玻璃体视网膜病变(PVR)的临床疗效。

方法：选取2015-01/2018-01我院眼科收治的脉络膜脱离后PVR患者64例66眼，采用随机数字表法分为对照组(32例34眼)和观察组(32例32眼)，对照组采用常规玻璃体视网膜手术治疗，观察组采用常规玻璃体视网膜手术联合玻璃体腔内注射康柏西普治疗。比较两组患者的临床疗效，手术持续时间、术中出血情况、医源性裂孔发生率及治疗前后的最佳矫正视力(BCVA)、黄斑中心凹下脉络膜厚度情况。

结果：术后随访3～6mo，观察组临床疗效总有效率(94%)显著高于对照组(74%)，差异具有统计学意义(P<0.05)。观察组患者手术持续时间显著短于对照组，术中出血及医源性裂孔发生率均显著低于对照组，差异均有统计学意义(P<0.05)。治疗前，两组患者血清血管内皮生长因子(VEGF)及碱性成纤维细胞生长因子(bFGF)水平差异均无统计学意义(P>0.05)； 治疗后以上指标均较治疗前下降，且观察组患者血清VEGF及bFGF水平显著低于对照组，差异均有统计学意义(P<0.05)。治疗前，两组患者BCVA及黄斑中心凹下脉络膜厚度差异均无统计学意义(P>0.05)，治疗后4、12wk两组患者BCVA均较治疗前提高，黄斑中心凹下脉络膜厚度均较治疗前下降，且观察组BCVA显著高于对照组，黄斑中心凹下脉络膜厚度显著低于对照组，差异均有统计学意义(P<0.05)。

结论：玻璃体切割术联合玻璃体腔内注射康柏西普治疗脉络膜脱离后PVR具有良好的效果，可有效缩短手术时间和减少术中出血及医源性裂孔的发生率，降低血清VEGF水平及bFGF含量，提高患者视力，降低脉络膜厚度。

Abstract:

AIM: To evaluate the clinical effect of Conbercept combined with vitrectomy in the treatment of proliferative vitreoretinopathy(PVR)after choroidal detachment.

METHODS: From January 2015 to January 2018, 66 eyes of 64 patients with PVR were treated in our hospital. All the patients were randomly divided into control group(32 cases, 34 eyes)and observation group(32 cases, 32 eyes). The control group was treated with routine vitreoretinal surgery. The observation group was treated with routine vitreoretinal surgery combined with intravitreal injection of conbercept. The clinical efficacy, operative duration, intraoperative bleeding, incidence of iatrogenic holes and the best corrected visual acuity(BCVA), subfoveal choroidal thickness before and after treatment were compared between the two groups.

RESULTS: After 3-6mo follow-up, the total effective rate in the observation group(94%)was significantly higher than that in the control group(74%), and the difference was statistically significant(P<0.05). The duration of operation in the observation group was significantly shorter than that in the control group, and the incidence of intraoperative hemorrhage and iatrogenic hiatus were significantly lower in the observation group than in the control group(P<0.05). Before treatment, there was no significant difference in serum VEGF level and bFGF content between the two groups(P>0.05). After treatment, the above indexes were lower than those before treatment. The levels of serum VEGF and bFGF in the observation group were significantly lower than those in the control group(P<0.05). Before treatment, there was no significant difference in the thickness of subfoveal choroid and BCVA between the two groups(P>0.05). The BCVA of the two groups was significantly higher than that before treatment. The thickness of subfoveal choroid in the observation group was significantly lower than that before surgery(P<0.05), and the thickness of the subfoveal choroid in the observation group was significantly lower than that in the control group(P<0.05).

CONCLUSION: Vitrectomy combined with intravitreal injection of conbercept in the treatment of PVR after choroidal detachment has a good effect. It can effectively shorten the operation time, reduce the incidence of intraoperative hemorrhage and iatrogenic hole, and reduce the level of serum VEGF and bFGF content. Improve the visual acuity and reduce the thickness of choroid.